Provider Demographics
NPI:1710297270
Name:JEWELL, JESSICA JO (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JO
Last Name:JEWELL
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-7895
Mailing Address - Country:US
Mailing Address - Phone:417-520-6298
Mailing Address - Fax:
Practice Address - Street 1:1009 N 26TH ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7895
Practice Address - Country:US
Practice Address - Phone:417-520-6298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010036070363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429582406Medicaid